Dermatology Flashcards
What is polyarteritis nodosa
Necrotising vasculitis of the muscular arteries
Symptoms of polyarteritis nodosa
Rash
Blackening ulcers
Dark in colour
Fevers
Fatigue
Weakness
Rash
Ulcers
Blackening rashes
Fever and fatigue
What does the patient have?
Polyarteritis nodosa
What is erythema nodosum
Hypersensitivity reaction
Inflammation of the subcutaneous fat
- painful nodules on the shin
More likely if you have Crohn’s disease
Pruitic rash on flexors of elbows is?
Atopic eczema
Patient has red rash on skin after being exposed in the sun for a long period of time
Discoid lupus eruthematosus
Dermatophytosis = ring worm
Circular lesions that are red and scaly
Impetigo signs
Golden and crusty lesion
Actinic keratosis
Skin condition which can cause squamous cell carcinoma
Signs Of actinic keratosis
Thick black plaques on the skin
Risk factors for getting actinic keratosis
Sun exposure
Management for actinic keratosis
5-flurouracil
What is SJS
Life threatening skin condition which causes a sudden painful rash
Why does SJS happen
Due to reaction to medicines like NSAIDS or viral infection
What is HSV herpes
Causes target lesions
What does streptococcus pyogenes cause
Bacterial tonsillitis
What is pityiasis rosea
Common rash that occurs after upper RTI
Causes widespread rash
Severe itch getting worse
More tired than usual
Cause?
Iron deficiency anaemia
Candida albacans
Rash that occurs in areas that fold
Haemanigioma
Proliferations of vascular endothelium
Pink and patchy
red lesions over legs that are painful to touch
erythema nodosum
- more common in women
- causes a painful rash
causes of erythema nodosum
it is lymphocytic vasculitis
- can be caused due to drug reactions
- chlamydia infections
- viral infections
what is acne rosacea
flushing of the forehead, nose, cheeks and chin
what kind of rashes does acne rosacea consist of
papules and pustules
what makes acne rosacea worse
spicy foods
sun
warm showers
hot weather
management for acne rosacea
topical antibiotics - tetracyclines (e.g. doxycycline, minocycline), macrolides (e.g. erythromycin, clarithromycin), and metronidazole.
what are topical corticosteroids used for
eczema and psoriasis
why should corticosteroids never be used for treatment of acne
it will worsen symptoms after a few weeks
what is the management for acne vulgaris
topical benzoyl peroxide
what is topical vitamin d analogue used for
psoriasis to help reduce the rate of skin turnover
large red rash on child, that is just getting bigger
it is bright red
what can it most likely be
haemangioma
what is the best management of haemangioma in children
leave it and do nothing
it typically goes with age
staphylococcal scaled skin syndrome - what is it
toxins on the epidermis are released from staphylococcus aureus
this causes intra-epidermal blistering
how does staphylococcal scaled skin syndrome present
it first presents as a red, scald rash
then goes onto causing peeling
why does staphylococcal scaled skin syndrome happen
common in infants
immature renal system which means they struggle to filter out toxins
treatment of staphylococcal scaled skin syndrome
IV antibiotics - flucloxacillin, cefotaxime, or clindamycin
which antibiotics are used to manage acne
tetracyclines, doxycyline
which antibiotics are used to manage acne
tetracyclines, doxycyline
what treatment medications used to treat acne are contraindicated in pregnancy
retinoids and tetracycline
symptoms of SJS
blisters and feeling of the skin
eosinophilic folliculitis
papular rash around hair follicles that is around the chest and neck
rash is very itchy
in what patients is eosinophilic folliculitis more common in
immunosuppressed like those who have HIV
treatment of eosinophilic folliculitis
HAART and topical corticosteroids
eczema herperticum - what is it
serious complication of atopic eczema
symptoms of eczema herperticum
widespread red rash and blisters
fevers
malaise
treatment for eczema herperticum
immediate treatment with IV aciclovir
what is pyoderma gangrenosum
deep pustular ulcer that occurs in a site after a minor injury
edges of the ulcer are blue/red
very painful
causes of pyoderma gangrenosum
autoimmune hepatitis
rheumatoid arthritis
leukemia
management of pyoderma gangrenosum
corticosteroids eg. prednisolone
tuberous sclerosis
angiofibromas (small red dots) that are on the face in butterfly distribution
leathery patches
white macules
what other symptoms can tuberous sclerosis cause
benign tumour in brain
can cause epilepsy
learning difficulties
behavioural abnormalities
fragile superficial blisters that are caused by IgG deposition
seen on the epidermis
seen as “chicken-wire”
pemphigus vulgaris
what is pemiphigoid gestationis
deep blisters due to IgG deposition on the basement membrane
only seen in pregnancy
which condition causes dermatitis herpetiformis
coeliac disease
acne is caused by which bacteria
cutibacterium propionibacterium
what does staphylococcus aureus cause
cellulitis and impetigo
what is seborrheoic dermatitis
Cradle cap
seen in infants
yellow greasy scales on the scalp
treatment for seborrheoic dermatitis
massage olive oil
what is a keloid scar
it is an abnormal over-proliferation of scar tissue after an injury
patient has itchy rash and burning sensation in mouth on eating
irregular purple plaques on the wrist covered with white lacy lines
what is it?
lichen sclerosis
what is lichen sclerosis
affects genitals
causes inflammation and destruction of genital tissue
causes ulcers in the mouth
management of lichen sclerosis
corticosteroids
what is dermatofibroma
firm, brown/yellow/pink coloured nodules
found in the lower leg
when squeezed - shows a dimple
deep painful ulcer on shin
pustular surface of ulcer with blue overhanging edge
what is the likely cause of this ulcer?
crohns disease
patient is suffering with pyoderma gangrenosum - most common in inflammatory bowel disease
what is seen in peripheral aterial disease induced ulcers
the ulcers will be punched out and skin around it will be cold, white and shiny
diabetic ulcer features
these happen on pressure points like soles of the feet
shiny yellow patch on the skin
what features are consistent with pemphigus vulgaris
involvement of the oral mucosa
what are comedones
dilated sebaceous follicules in the skin - pores
they can be open (blackheads) or closed (whiteheads)
what is the management of mollyscum contagiosum
watch and wait
patient has blisters all over the body that is spreading all over the body
fever
soreness
when the blisters burst they leave raw patches
happened after a graze to the knee
likely diagnosis
staphyl scaled skin syndrome
patient has rash and longitudinal rashes on finger nails
what is this a sign for
lichen planus
patient has fever and target lesions and then ulcers in mouth
takes lamotrigine
what is the likely cause of her symptoms
stevens johnson syndrome
side effect of lamotrigine use
bumpy red rash over buttocks and painful knees
occurs after an infection
what is the diagnosis
henoch-schonlein pupura HSP
what is impetigo
golden crusty lesions
found around the mouth
very itchy
very contagious
what bacteria causes impetigo
staphyl aureus
management of impetigo
hydrogen peroxide 1% cream
oral flucacilin
what is erythema nodusum - symptoms
fever
joint pain
more common in women
linked with - IBD and colitis
happens due to a hypersensitivity reaction
throat pain
what is eczema herpeticum
secondary viral infection
develops fro atopic dermatitis
small vesicles in the skin
erupt on their own and causes scarring - when can then cause more infections
can cause sepsis
Kawasaki disease - what is it
swelling of the coronary blood vessels
swelling of the heart valves
symptoms of Kawasaki disease
strawberry tongue
pink rash
pink scraped lips
peeling of hands and feet
blood shot eye
what is erythema multiforme
target lesions
pink plaques
darker centre
3 rings of colour
starts in the palms of hands
in areas of cuts
itchy
which bacteria that is found in the soil causes gas gangrene - blackening and necrosis and then death
clostridium perfrinigens
which bacteria is found in the intestines
e.coli
puritic rash with wheels and swellings
hives
features of slapped cheek syndrome
lethargy
headache
sore throat
runny nose
fever
erthymatous rash on cheeks and torso
how long can children not go to school for if they have slapped Cheek syndrome
children are no longer infectious once their rash appears - they can go to school
what are the benign skin conditions?
lipoma
histiocytoma
haemangioma
caseous cysts
seborrheic keratosis
what is lipoma
benign tumour of the adipose (fat) cells
small
squishy
what is histocytoma
BENIGN
tiny
hard lumps under the skin
what is a haemangioma
BENIGN
large blood collection vessel that looks like red worms
collection of blood vessels that form a Lump under the skin
can be called ‘strawberry marks’
common in children
what are caseous cysts
BENIGN
boils/ pus filled cysts on the skin
what is seborrheic keratosis
BENIGN
originates from the cells on the outer layer of the skin
brown/black spots on the body
common in older people
slightly raised spots that are scaly or waxy looking
what is actinic keratosis?
chronic sun damage
pre cancerous condition
scaly rash like on head/chest
sun exposed areas
common on bald men
can turn into squamous cell carcinoma
squamous cell carcinoma - pathophysiology
abnormal accelerated growth of the squamous cells
very aggressive and fast spreading
common site for it is the mouth and lungs but can be found on the skin too
looks like a lesion with new vascularisation
what is melanoma
cancer of the melanin cells that give colour to the skin
uneven borders
irregular colouration
common feature of basal cell carcinoma?
raised and circular
with a central dip
very slow growing
acne rosacea - symptoms
redness around the nose and mouth
‘butterfly’ shaped
painful spots that are big
raised lumps
what medications can be a reason for poor prognosis of skin cancer
immunosuppressants
what rash is this:
vesicular rash
bubbly red
tingles/burns
shingles
what is shingles
shingles is the reactivation of the varicella zoster virus that stays in the basal ganglion
it spreads through the nerves to the skin and can cause the itching and tingling sensation
it is mostly only reactivated in patients who have a weak immune system
someone who has not had chicken pox can get it from being infected by someone with shingles. But if someone is immune to chicken pox they are not at risk from exposure to someone with shingles
acral lentiginous melanoma - what is it
- melanoma of the soles of the foot/palms/nails
- most common type of melanoma in people with darker skin
what is hand foot mouth disease
- commonly affects children
- rashes on hands and feet
- painful mouth ulcers
- common in children in nurserys
- children won’t feed well
- goes away by itself
what is impetigo
bacterial infection
causes golden crusty flaky rash around mouth
give hydrogen peroxide
what is folliculitis
inflammation of the hair follicle
what is tibia corpurous
fungal infection
known as ring worm
active inflammation around the edges but the middle is normal - hence the ring shape
give anti fungal for it
why does psoriasis happen
due to the very quick turnover of the skin cells - hence the flaky skin
problems of chicken pox in pregnant woman?
congenital abnormalities in baby
erythema multiforme
reactive inflammation - due to a trigger
- clear centre (bullseye rash)
- can be all over the body
NOT PAINFUL
the skin is made of three main layers - which ones
epidermis
dermis
sub cutaneous
the role of the epidermis and what it is made of
it is made from stratified squamous epithelium
and its role is in homeostasis in maintaining body temp
keratinocytes migrate from the basal layer to the epidermis and die along the way
what is the role of filaggrin
acts like a natural. moisturising factor for the skin
having less of this can cause the skin to crack and become open to diseases
- mutations in the expression of fillagrin is a risk factor for eczema
how long does it take for keratinocytes to travel from the Basel layer
30 days
this turnover is a lot faster in psoriasis - which causes the flaky skin
what do keratinocytes produce that protect against bacteria
cytokines - these help with wound healing as wwell
what is the dermis made of
collagen and elastin fibres- these make the skin more flexible
- it also contains fibroblasts and lymphocytes which protect against infection
what is the papillary dermis an reticular dermis
papillary - contains the capillary network
reticular - thicker and denser
there is also sweat glands here
what do the sabeous glands release
they are inactive until puberty
they release oils under the influence of androgens
is the skin innervated with
sensory fibres that are responsible for priorioreception, heat and pain
what is erythroderma
it is when over 90% of the skin gets inflamed
mainly due to drug hypersensitivity
it can cause fevers, thirst, dehydration and hypothermia
pathophysiology of acne
abnormal keratinisation and increase sebum production causes the sabecous gland to become blocked
if this gets attacked by bacteria it makes it worse and the innate immunity causes connective tissue damage
neutrophils attack the gland
if the lesions are non-inflammatory: blackheads, open pores
inflammatory: papules and pustules that are filled with pus
why does puberty make acne worse
the sabecous glands are inactive before puberty and androgens that are released during puberty cause the production of sebum
this is why acne is worse during puberty
- also why the combined pill is useful in reducing acne coz it regulates the androgen levels
what is rosacea
inflammatory rash with papules and pustules
- it is worse with sunlight and alcohol
- no comodones
treatment - topical metronidazole
with oral tetracyclines
- rash happens around the nose and mouth in a diamond shape
allergic contact dermatitis is mediated by what?
it is a IV hypersensitivity reaction which is caused by T lymphocytes
erythema multiforme happens due to mainly which virus?
Herpes simplex virus
what is dermatomyosistitis
when there is skin changes and also proximal muscle weakeness
causes heliotrope rash - purple rash on eyelids
scaly rash on knuckles
pyoderma gangrenosum what is it
it is an inflammatory skin condition which causes painful ulcers post minor trauma
commonly happens in the lower limbs
it causes a deep ulcer that is irregular and has a purple border
very common in other inflammatory conditions eg, IBD or RA
give oral predinosolone
what is pityriasis rosea
it is a rash caused by HHV7
it causes a rash that is pink and raised on the trunk and the back
what is a marjolin ulcer?
a squamous cell carcinoma that develops on ulcers and burns and other wounds
it is generally flat and hardened with elevated margins
what is post herpetic neuralgia
pain in the area of where shingles affected the body, and the pain is characterised by tingling, burning etc
management of impetigo
fusidic acid
if that doesn’t work then: flucloxacillin
management of tinea ring worm
ketoconazole
management of rosacea
topical metronidazole
management of urticaria (hives)
causes itchy skin coloured wheals on the skin
manage with: Oral Cetirizine
second line: oral prednisolone
management for cellulitis
if patient is heamodynamically stable but is on immunosuppressants - then admit immediately for IV antibiotics
what is Porphyria cutanea tarda
what is a traumatic ulcer
an ulcer that occurs due to trauma and doesn’t heal
isn’t as painful as venous and atrial ulcer
